Treatment for Cervical Spondylosis (Arthritis of the Neck)
In most cases, treatment for cervical spondylosis is nonsurgical. Nonsurgical treatment options include:
Physical therapy. Physical therapy is usually the first nonsurgical treatment that your doctor will recommend. Specific exercises can help relieve pain, as well as strengthen and stretch weakened or strained muscles. In some cases, physical therapy may include posture therapy or the use of traction to gently stretch the joints and muscles of your neck. Physical therapy programs vary in length, but generally last from 6 to 8 weeks. Typically, sessions are scheduled 2 to 3 times per week.
Medications. During the first phase of treatment, your doctor may prescribe several medications to be used together to address both pain and inflammation.
Acetaminophen. Mild pain is often relieved with acetaminophen.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Often prescribed with acetaminophen, NSAIDs such as ibuprofen and naproxen are considered first-line medications for neck pain. They relieve both pain and swelling and may be prescribed for a number of weeks, depending on your specific symptoms. Other types of pain medication can be considered if you have serious contraindications to NSAIDs or if your pain is not well controlled.
Muscle relaxants. Medications such as cyclobenzaprine or carisoprodol can be used to treat painful muscle spasms.
Soft cervical collar. This is a padded ring that wraps around the neck and is held in place with velcro. Your doctor may advise you to wear a soft cervical collar to limit neck motion and allow the muscles in your neck to rest. A soft collar should only be worn for a short period of time since long-term wear may decrease the strength of the muscles in your neck.
Ice, heat, and other modalities. Your doctor may recommend careful use of ice, heat, massage, and other local therapies to help relieve symptoms.
Steroid-based injections. Many patients find short-term pain relief from steroid injections. The most common procedures for neck pain include:
Cervical epidural block. In this procedure, steroid and anesthetic medicine is injected into the space next to the covering of the spinal cord ("epidural" space). This procedure is typically used for neck and/or arm pain that may be due to a cervical disk herniation, also known as radiculopathy or a "pinched nerve."
Cervical facet joint block. In this procedure, steroid and anesthetic medicine is injected into the capsule of the facet joint. The facet joints are located in the back of the neck and provide stability and movement. These joints can develop arthritic changes that may contribute to neck pain.
Medial branch block and radiofrequency ablation. This procedure is used in some cases of chronic neck pain. It can be used to both diagnose and treat a painful joint. During the diagnosis portion of the procedure, the nerve that supplies the facet joint is blocked with a local anesthetic. If your pain is relieved, then your doctor may have pinpointed the source of your neck pain. The next step option may be to block the pain more permanently. This is done by damaging the nerves that supply the joint with a "burning" technique—a procedure called radiofrequency ablation.
Although less invasive than surgery, steroid-based injections are prescribed only after a complete evaluation by your doctor. Your doctor will talk with you about the risks and benefits of steroid-based injections for your specific condition.
Surgery is not commonly recommended for cervical spondylosis and neck pain unless your doctor determines that:
A spinal nerve is being pinched by a herniated disk or bone (cervical radiculopathy), or
Your spinal cord is being compressed (cervical spondylotic myelopathy)
Patients who have progressive neurologic symptoms, such as arm weakness, numbness, or falling, are more likely to be helped by surgery.
Surgery may also be recommended if you have severe pain that has not been relieved by nonsurgical treatment. However, some patients with severe neck pain will not be candidates for surgery. This may be due to the widespread nature of their arthritis, other medical problems, or other causes for their pain, such as fibromyalgia.